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Worried about slow weight gain in my 10 week old

Hello- I posted a little over a month ago about some issues I was having with slow weight gain and lack of dirty diapers.

A quick backstory- my 4th child was born (by my 4th c-section) on 10/2. He was 8lbs 15oz, and dropped to 8lbs 0oz. He did not regain birthweight until 3 weeks 5 days. Since then, he has been pretty much gaining 1lb every 3 weeks, or approx. 5oz per week. Currently at 10 weeks 4 days he is 11lbs 3.5oz (I have a scale at home that I weigh him on daily (naked), and it has always been within 1/2oz-1oz of the Dr's scale. He has gone from the 90th percentile at birth, to 50th at 1 month (and we were doing a lot of EBM supplementing at that time- we had one stretch that he gained 14oz in 14 days). At 2 months he was in the 25th percentile. His head circumference went from the 25th percentile at 1 month, to the 15th percentile at 2 months. His length has stayed consistent at the 80th percentile. I felt comfortable with him gaining 5oz per week (even though this is WAY less than my other kids gained- this baby was my biggest at birth and my smallest at 2 months), but the last 2 weeks he has gained less than that, which I am not super comfortable with. He stalled at the same weight for about 5 days last week, and his net gain was only 2.5oz for the week last week. I panicked and supplemented with 3, 2oz bottles of EBM (I am still renting a Symphony and have been only pumping once in the morning for the last 5-ish weeks). The next day he was up 4 oz. I supplemented with 2, 2oz bottles that day and the next day he was up another 1.5 oz. One trouble I have is that he only poops 1-2 times a week, and when he goes, he loses weight and takes a few days to recover. I have been giving 2, 2oz bottles of EBM all week, although today I only gave 1, 2oz bottle. So Tuesday he was 10lbs 13.5 oz (for the 5th day in a row) Wednesday he was 11lbs 1.5 oz, Thursday 11lbs 3oz, Friday (after pooping) 11lbs 1.5oz, Saturday 11lbs 2.5oz and today 11lbs 3.5oz. I do NOT want to get back to needing to supplement, and while on paper I know his weight gain is acceptable (barely)- I just feel like he should be gaining more. My ped. is okay that he dropped percentiles but said if he drops more at 4 months she will do bloodwork (what would they be looking for)?

I feel like my milk supply is fine. While I have dealt with true oversupply in the past, I definitely don't have that this time. But I feel like it is enough. I pump in the morning 4-6oz total, and get 2.5-3oz if I ever pump in the afternoon. He is a super soaker when wetting diapers and he is meeting milestones. I know the milk is letting down just fine (albeit slower than I have had in the past) He is with me 24/7 and is free to nurse 24/7 (we cosleep). I don't know what else to do. He has been looked at by 2 IBCLC's and neither think there is a tongue or lip tie. I have never had pain and his latch seems fine. When he does poop it is always the right consistency and color. There is a 3rd IBCLC I could see (for a different perspective) but it is expensive and I am not sure a before/after weight feed will help at this point, because the amount has been right in the past. Should I see an ENT just to see about a posterior tongue tie? My husband and I are not tiny people, and all 3 of my other kids have been in the 50-75th percentile. I just feel like there is a piece missing to the puzzle and I am not seeing it. I just cannot figure out why he isn't gaining better. I just feel in my gut that he should be gaining more than he is- his overall net total for the last 6 weeks (42 days is 30 oz)

Re: Worried about slow weight gain in my 10 week old

Baby is free to nurse 24/7. But does baby nurse very frequently? Some nutritional deficiencies can cause a lack of appetite. And pacifier use and swaddling MIGHT cause a baby to nurse less frequently than they should.

Based on what you have written here, I have to say if it were me, I would press for testing now rather than later. You seem to have plenty of milk, so that is not the problem. 2 IBCLCs have said there is no tt and (I assume) you also see no evidence of tt (or do you?) and before and after nursing weight checks have been normal.

So if there is enough milk, and baby can get it out normally, that leaves 1) Baby is not nursing frequently enough 2) there is a medical issue or 3) this is just who your baby is.

What would they test for? I think that is a question for your doctor, I imagine there are many things illnesses or conditions that would lead to poor gain. Things that I am aware of that can cause poor gain are allergies, heart conditions, nutritional deficiencies (very low iron or B12.)

Re: Worried about slow weight gain in my 10 week old

Thanks for the response. The baby nurses frequently throughout the day and night. Typically not longer than every 2 hours, he has never gone more than 3.5. He has never been swaddled. Doesn't really take a pacifier, we only really try when in the car. The first couple weeks his before/after weights were not good and I was told he was not transferring well. The last time we did one was at 1 month and he took 3.5oz. I do not see any evidence of a tongue tie, and there are no symptoms other than slow gain. At this point if he wasn't transferring well would I be maintaining my supply? He did gain better with the extra supplements this week, which makes sense but I cant figure out why he doesn't gain as well just nursing. Again, everything seems right, except the weight gain.

Re: Worried about slow weight gain in my 10 week old

Would you consider renting a professional scale and doing some before-and-after weights on your own? Getting a weight done at the IBCLC's office is expensive, and also not that informative because it only provides a one-time snapshot of intake. If you have a couple days' worth of data, that tells you a lot more about the baby's average intake.

Re: Worried about slow weight gain in my 10 week old

Originally Posted by @llli*mommal

Would you consider renting a professional scale and doing some before-and-after weights on your own? Getting a weight done at the IBCLC's office is expensive, and also not that informative because it only provides a one-time snapshot of intake. If you have a couple days' worth of data, that tells you a lot more about the baby's average intake.

Thanks for the suggestion. I have been looking and it seems scale rentals are about $80 per month (or $30 per week) around me. I may be able to do this after the holidays- I wouldn't have guessed it would be more than the pump!

He has actually put on some weight this week. In addition to the EBM supplements I mentioned in my original post- he got 1, 2oz bottle yesterday. He was 11lbs 7.5oz today, which is 10oz in 7 days. That makes me think there still might be a transfer issue? If I am able to pump some extra milk and feed it to him and he gains weight- why is he not able to do the same by only nursing? He has only received 2 extra ounces the last 3 days, so maybe that will not show up until a few days from now- but I am surprised. He is becoming more resistant to taking anything from the bottle, today I could only get him to take about 1oz and had to toss the other oz because he didn't drink it quick enough.

I do have my own scale that weighs to the .5 oz. I know that is not super accurate for before/after feeds but maybe it can give me a rough idea before I am able to rent a scale.

Re: Worried about slow weight gain in my 10 week old

You probably wouldn't need the scale for a month- maybe just a few days to a week. If the scale shows that intake is sufficient, then you know that the issue isn't milk supply, it's just a baby who is a different physical type from your others. Scale goes back, leaving you at ease.

Now, if the scale shows that baby's intake is low, then it might make sense to hold onto it for a while longer, and see if you can find ways to increase the amount the baby takes at a feeding.

I agree that the scale you have isn't the right tool for the job, but I'd make use of it anyway. First, it can help you get into practice for when you do have the professional scale, and second, if there's an obvious lack of intake, it may show up even at the coarser resolution on your current scale.

Re: Worried about slow weight gain in my 10 week old

I agree getting an idea of intake is a good idea. Except I am not positive what would normal daily intake is for a 10 week old baby! Different sources say different things-Maybe this is question for one of the IBCLCs you saw, but its going to be an average, and the sources I have seen say anything from 20-40 ounces per day is normal daily intake for a newborn, and I assume its not too much different for a 10 week old. .

But I caution about weighing baby too frequently for measuring overall gain. Charts are set up for periodic weight checks, usually several months apart. Weight gain normally fluctuates a great deal day to day and week to week. Also gain rate typically drops off quite a bit at ~3 months and you are pretty close to that, so keep that in mind.

Re: Worried about slow weight gain in my 10 week old

I just wanted to update this. My baby is no longer in the 0-3 month category (he is 3.5 months). He is now currently 15w5d and is 12lbs 13oz. I did not end up renting the scale, but did meet with the 3rd IBCLC. She watched him nurse and checked his mouth again. She said he had a high palate and possible posterior tongue tie. She did a before/after feed and he transferred 3oz. She recommended we see a pediatric ENT to evaluate for tongue tie. We did that last Friday and the ENT did not see ant indication of any tongue tie- posterior or otherwise. So now the IBCLC is recommending we boost my supply to hopefully get him to take more during a nursing session. She would like me to do a power pump and take More Milk Plus. I am still pumping once a morning and getting 5-6oz from that. I am still giving two 2oz bottles a day. He continues to average about 5oz/week, which means a drop in percentiles. He is now 20th percentile on the CDC chart and 9th on the WHO. Anyway- he is continuing to grow in length and head circumference. And while the weight gain is slow, it is consistent. He is meeting milestones and is perfectly healthy. If he wasn't dropping percentiles and was maintaining a curve I wouldn't be concerned at all. But I know the ped. is going to have an issue with that. I would also like to stop giving the 2 bottles a day and would love to stop renting the pump! Anyway- just wanted to give an update.

Re: Worried about slow weight gain in my 10 week old

Thanks for the update, mama! I really admire the hard work you're doing.

Since you're currently pumping more than your baby needs, you might want to consider offering him a bottle of double cream breastmilk. You pump one bottle, let it sit in the fridge until the cream floats to the top, then you pour the cream off into another bottle which you then feed to the baby. That way your baby gets one bottle with lots of extra calories, which might just boost him off the low end of the charts. Maybe.